If the COVID-19 pandemic has taught us anything, it is that global responses are needed to confront diseases that can spread around the world with stunning speed. It is no wonder, then, that the concept of global health diplomacy—including vaccine diplomacy—has become a major foreign-policy talking point everywhere from China to the United States.
Yet rhetoric aside, the predominant response to the disease has been to shut down and look inwards. As the global demand for medicines, medical supplies, and personal protection equipment increased, countries imposed export prohibitions and restrictions to stabilize domestic supplies. Vaccine nationalism was soon to follow, with the possibility that rich countries would attempt to hoard vaccines by striking pre-purchase deals with pharmaceutical companies.
Throughout it all, though, it was always clear that a global challenge of this magnitude would eventually require a global solution, based on international health cooperation between public and private-sector stakeholders. And Indian Prime Minister Narendra Modi recognized early on that his country could play a unique role in that process.
India is already known as pharmacy of the world. It is the largest producer of generic medicines, accounting for 20 percent of their global production. It meets 62 percent of the global demand for vaccines. Since the coronavirus pandemic began, the country has been at the forefront of supplying medicines and generic drugs to others. India received requests from more than 100 countries for hydroxychloroquine (once thought to help treat COVID-19) and paracetamol (a painkiller), and sent supplies to Brazil, the United States, and Israel. By May 2020, India was spending $16 million on pharmaceuticals, test kits, and other medical equipment for about 90 countries.
Even before multilateral organizations got on board, New Delhi also consistently supported measures to temporarily suspend COVID-19 vaccine intellectual property rights—which would mean it could produce generic versions at lightning speed whenever a vaccine was created—and sponsored a WHO resolution calling for international cooperation to ensure global access to the vaccine.
Despite challenges, India has launched the world’s largest COVID-19 vaccination drive this month. Companies such as Zydus, Bharat Biotech, and Gennova are developing indigenous vaccines. Others like Serum Institute are collaborating with foreign companies, namely AstraZeneca. The most promising two COVID-19 vaccines are the made-in-India Covaxin by Bharat Biotech and Covishield, by Serum Institute.
India will need more than a billion doses to protect its own population. But it also aims to offer 20 million doses to neighboring countries Nepal, Bangladesh, Sri Lanka, Afghanistan, the Seychelles, and Mauritius by this spring. It will then distribute vaccines to Latin America, Africa, and the former Soviet Republics. Many of the recipient countries have signed so-called vaccine pacts with India on a government-to-government basis to finalize the number of doses and determine whether they will be provided under grant assistance or under commercial terms. While commercial overseas shipments are likely to start around March, India has already sent 3.2 million free doses of the vaccine Bangladesh, Nepal, Bhutan, and the Maldives.
If the government can ensure that its domestic vaccine requirements are being adequately met, as seems to be the plan, there is little possibility of political blowback for Modi of sending vaccine elsewhere. Meanwhile, the foreign-policy benefits in strategic areas could be great.For instance, India is keen on mending its ties with Bangladesh. New Delhi’s controversial citizenship law enacted last year and the news of $40 billion in investments from China to Bangladesh had strained ties between the two nations. The COVID-19 vaccine can let a little slack back in. Similarly, vaccine diplomacy provides an opportunity for India to resolve outstanding issues with Nepal. Relations between the two countries recently hit a new low when they entered into a heated exchange over the Kalapani territorial dispute—an area situated at the strategic China-Nepal-India trijunction. In Indian Ocean countries like the Maldives and Mauritius, India’s vaccine diplomacy can help foster stronger ties in the region, and offset China’s growing influence attributable to its financial investments and social-development projects.
India’s vaccine diplomacy puts it in direct competition with China—which has made no secret that vaccine distribution is wrapped up in its broader geopolitical ambitions. In fact, it has even explicitly included vaccine distribution in its broader Health Silk Road initiative, which aims to bolster China’s international soft power
Vaccine manufacture and distribution is one area where India has some comparative advantage over China, but the competition between the two may still be fierce.
The quality and efficacy of Chinese vaccines have been questioned due to concealment of test data and lack of transparency in information. Recent reports have revealed that Brazil—which was initially planning to deploy China’s Sinovac—raised concerns about the efficacy and safety of the vaccine and ultimately decided to opt for India’s Bharat Biotech. Such outcomes will help India position itself as the more responsible global power. Simply put, India has longer track record of supplying medicines and vaccines to the rest of the world, especially to low- and middle-income countries.
Nevertheless, China has one big advantage over nearly every other country: It has largely been able to control the pandemic within its borders, and its economy is mostly back on track. That means China can potentially devote more diplomatic attention and resources to its global vaccine outreach. However, unlike India, there is little transparency about the safety of efficacy of Chinese vaccines. The Brazil case shows the problems that can cause
Vaccines are the single most powerful health interventions developed by modern medicine. Universal, equitable, and affordable supply of vaccines for low- and middle-income countries are needed more than ever. In past epidemics, such as the H1N1 influenza, many developing countries were on the outside looking in when it came to access. India is now on the inside, and it can play a crucial role in health and safety in an increasingly interdependent world.
